ONLINE POST in ENGLISH, commissioned | AMP Student 2016;16
The acquisition of skills in medicine is a dynamic concept and, as such, permanently changing. Skills are acquired, improved and maintained by specific training, to ensure the best quality of the delivered care. Provide the best training and most constructive learning experience has always been a concern of educators, decision makers, and society. Yet, pressures arising from the limited receptivity of patients to be involved in training, cost cutting, limited instruction time, increasingly complex technical procedures, and ethical issues have placed unprecedented constraints on training, making systematic training in real settings unattainable.
Literature suggests that undergraduate clinical teaching is inadequate in terms of consistency of skills taught to medical students and competencies achieved. There is evidence of a mismatch between skills taught and those necessarily required for practice and of students’ dissatisfaction with their training. Several reasons can be pointed to justify medical students suboptimal training, such as lack of practical experience in medical school, curricular deficiencies, differences in teaching quality and/or quantity for students at different teaching sites, lack of confidence rather than competence, and poor coordination of undergraduate and early postgraduate training phases.
Simulation based medical education (SBME) can provide a supportive educational environment, allowing users to practice and develop skills without any discomfort or risk to real patients. It encourages the acquisition of skills through experience, ideally in a realistic situation or environment, and can stimulate reflection on performance. As opposed to the clinical setting, where errors must be prevented or repaired immediately to protect the patient, in a simulated environment errors may be allowed to progress, so as to demonstrate their implications to the trainee, or to enable a quick reaction to rectify them.
SBME is an effective education complement for medical training, both at undergraduate and postgraduate level, which enables knowledge, skills and attitudes to be acquired in a safe, educationally orientated and efficient manner. In this context, simulation provides skills and experience that facilitate the transfer of cognitive, psychomotor and proper communication capacity, thus helping to improve behavior.
The model for medical education is clearly changing from a teacher centred, apprenticeship model to one that incorporates simulation as a complement to clinical exposure, in a framework that incorporates mastery learning, reflective and deliberate practice to achieve the expected competencies. In fact, experiential skills-based teaching is the common pathway that converts knowledge and attitudes into behaviour and action.
The model “See one, do one, teach one” has reached to an end. The predominantly observational and patient-dependent training unables repetition and standardization, and no longer meets the current needs and challenges of medical education. Simulation based medical education will not substitute the traditional learning or patient encounters. Instead, will complement the traditional curriculum, providing additional steps on clinical skills development and competencies proficiency, with a transferability of skills to clinical practice.
A new model is emerging: “See one, simulate many, do one competently, and teach everyone”!
Circle of learning in healthcare
(Adapted from: http://www.laerdal.com/docid/6681900/The-Circle-of-Learning (accessed on July 20th, 2016))
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